As the saying goes, "If you
don't know where you are going, you're sure to get there." Every medical
facility and physician practice needs to understand "Who They Are" and "Where
They Are Going" in order to make logical, focused, and profitable business
decisions that will benefit them for the long term. "Ready, Fire, Aim" no
longer works in today's medical environment.
In addition to
operational assessments, our firm can facilitate your strategic planning process
and help marry your vision to the world in which you operate. While the
strategic planning process is different for each client, some discussion topics
may include:
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Charter and
Vision Statement development
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Identifying
forces affecting your practice
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Assessing
operational concerns
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Aligning the
governance structure with your Vision
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Identifying
strategic affiliations
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Identifying
marketing, technology and other opportunities
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Assessing
current resources vis-à-vis those needed to achieve the corporate Vision.
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Defining a
range of strategic alternatives given corporate constraints, the Vision, and
opportunities and threats.
The
benefits of this exercise include gaining better control of your future,
recognizing business opportunities and threats, setting measurable goals and
objectives, and realigning the "corporate compass".
Physician
Compensation Plan Development
Physician compensation is a
cornerstone of the long-term practice strategy. Developing a compensation
program that is viewed as fair by all (not perfect), rewards appropriate
behavior, and is consistent with the strategic plan of the practice is the key
to harmony and practice stability. Understanding the pitfalls of different
options and legal constraints (e.g., Stark law) is critical to successful
implementation of any compensation plan. MediCo has worked with practices
as large as 110 physicians to develop and implement such successful compensation
plans.
If your
practice has not developed a
strategic level plan or addressed physician compensation in the last 3 years, now is the time to
step back and reassess where you want to be in the next 3-5 years. Call us
to facilitate that discussion.
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Physicians desiring to
start their own independent practice need to understand the “Five P’s”, Poor
Planning Promotes Poor Performance. It’s a lot
better to take the time and spend money to get it right the first time than
to waste time and throw away money fixing problems due to hastily opening
your clinic doors for business. Below is a brief checklist that will help
you understand the complexity of starting up a new practice. MediCo
Unlimited welcomes the opportunity to get your practice up and running
properly. MediCo and its affiliates assist in resolving your:
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Facility Needs
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Financial Needs
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Legal Needs
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Staffing Needs
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Technology Needs
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Clinical Processes -
Transcription, Answering Service, Process Flow Development
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Business Development &
Marketing Needs
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Billing & Collections
Services Needs
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Supply Needs- Office
and Clinical
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Policy Manuals &
Business Forms Needs
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Operations Management
Needs - Administration, Accounting, Payor Contracting
MediCo can
also assist the practice with
preparations for sale, merger or other strategic affiliation by:
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Locating
potential buyers
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Compiling
practice marketing information / prospectus
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Performing required financial due
diligence.
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Determining the value of the practice
to be sold, merged or purchased.
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Coordinating the entire practice
wind down process.
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Current pressures on practices dictate a closer look at medical practice
operations, especially for growing practices. Good practice management requires
that administrators perform comprehensive diagnostic reviews of all aspects of the medical practice,
especially those directly impacting the cash flow of the practice. However,
most Administrators do not have the time to stop day-to-day operations to
perform comprehensive assessments of the practice.
In addition to practices experiencing declining
reimbursement, more inefficient operations, and other general "practice decay",
Frost & Company and the Southern Medical Association (1/03) state that during any five (5) year period of time, over eighty percent (80%)
of all medical practices will experience embezzlement in one form or another.
Additionally, of those committing the embezzlement, it is estimated that seventy
(70%) have practiced their embezzlement skills with a previous medical practice.
MediCo Unlimited is highly skilled in performing operational assessments and
subsequently providing the tools for management to improve weaker areas of the
practice or better insulate themselves from embezzlement. We have the industry
data and operational standards to provide you with the “bigger picture” you need
to compete in today’s environment. The scope of the assessment depends
on whether you have targeted suspicions of underperformance or an overall sense
practice performance is not optimized. The benefits of these assessments are
obvious.
Internal Controls
& Personnel Assessment
Internal Controls - Separation of Duties,
Write-offs, Daily Balancing
Staffing - Gaps,
Skill sets, Outsourcing vs. In-House
Payor Assessment
Analyze Payor Mix - Including Shifts, Declines in Rates.
Collection Rates - Actual and Optimal Given Payor Mix
Accounts Receivable Assessment
Analyze Payor Class & Collectibility
Benchmarking
EOB Review
Analysis of Denied Charges, Payment Speed, Reimbursement Inconsistencies
Fee Schedule & Paid Claims Review - Underpayments and Full Fee Payments
Billing and Collection Processes Assessment
Patient Scheduling & Demographics
Patient Check-in and Check-out
Charge Capture, Dictation, Patient Statements
Claim Filing
Unpaid Balances Follow up - Commercial and Personal
Collections, Hardships and Alternative Revenue Solutions
Charge Ticket Review (Office, Hospital,
Surgical)
Review for Missing or Obsolete Codes, Optimization for More Accurate Coding
Coding Analysis
Utilization Review - Compliance with Law and Maximization of Income
Physician Analysis
Production & Compensation
Governance Issues Affecting Operations
Call us today for a free consultation if you haven’t performed these
assessments in the past year.
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Contracting is the lifeblood of a medical practice. Having the proper
strategy and tools to manage this area from beginning to end can mean the difference between
physicians working longer hours for less pay or enjoying a better quality of work life
and financial solvency. Seek assistance from a firm that has been intimately involved with
contractual issues.
In July, 2004, Daniel P. Stech, MGMA
survey operations director stated, "We observed that a significant number of
survey respondents were likely unable to identify their contracted rates,
suggesting a lack of understanding for contracting effectiveness. The disparity
between reimbursement values and contracted values should prompt practices to
evaluate their contracts and audit payer performance."
He is correct. Knowledge is power. Knowing, legally, what constitutes good contract language
and good rates for reimbursement is the key to that power. MediCo Unlimited’s
principal, Jeff Eckert, is a sought-after contracting authority and has experience reviewing and negotiating hundreds of
contracts with virtually every major payor across the country. He has occupied
advisory Board positions with
hospital PHOs, payor committees, various practice
associations, and as Chief Financial Officer of large practices.
Our Services include:
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As part of the
strategic planning process, establishing a cogent contracting plan of action.
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Reviewing existing
contracts and identifying unacceptable contract provisions for areas of
improvement in economic (reimbursement) and non-economic language.
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Renegotiating poor
contracts.
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Contacting payors not
currently contracted with the client and negotiating participation in new plans.
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Analyzing insurance
payments for negative occurrences that may be a breach of your contract,
such as Silent PPO activity and improper payment or bundling.
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Seeking out new
business affiliations for the client in an effort, in part, to strengthen its
bargaining power regarding health care contracting (i.e., physician / hospital
organizations or independent practice affiliations).
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An ancient philosopher wrote, "When health is
absent, wisdom cannot reveal itself and intelligence cannot be applied". This
certainly pertains to businesses as well as people. A healthy practice is
a proactive practice. It has a process for systematically reviewing key
areas on an ongoing basis. MediCo can assist your administrator in this
time consuming process throughout the year. We call this our "Preventive
Care Plan".
While this process is customized depending on each client's
strengths, weaknesses, and time shortages, a yearly retainer allows us to
provide some or all of the following services:
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Monitor the revenue cycle (charge posting, accounts receivable,
payment posting). This is doubly important if you have outsourced your
billing and collection processes.
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Review financial decisions before they are made.
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Review internal controls.
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Assist with personnel and human resource questions. Answer
questions about employee issues and annually review job descriptions and
employee handbooks.
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Attend internal meetings as an unbiased advisor or external
meetings as an agent of the practice.
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Assist with the yearly budget process or business expansion
issues.
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Review outsourced legal, accounting, insurance, banking,
information systems, and billing work.
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Review internal programs to document compliance with CMS and OIG
mandates.
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Create or update financial, operational, HIPAA privacy, and HR
policy and procedure manuals.
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Assist the practice with software and hardware selection.
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Train your accounting and billing staff.
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Perform other advisory roles as needed.
The cost can be as little as $500 per month. What benefits
come from preventive maintenance?
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Improve the overall financial management of the practice.
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Give your practice more credibility with the banking and business
community.
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Create more time for your administrator to
manage the practice.
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Provide better information with which your administrator can make
better decisions, and
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Create more time for the physicians to practice medicine.
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As national reimbursement trends downward, practices must pursue
operational strategies to offset such declines. MediCo Unlimited utilizes proven
operations management and management (cost) accounting techniques to enhance
revenue and lower costs. Benchmarking solutions target where to focus
operational efforts and corporate finance solutions help provide access to
critical funding.
Revenue Enhancement
Cost/benefit analysis of the use of physician extenders, use of alternative
clinical modalities, targeted contract acceptance, selling underutilized internal services, and
increasing the utilization of existing equipment (or obtaining equipment in the first place)
are but a few of the potential strategies we utilize. Innovative strategies for
collecting self pay balances, instead of turning patients over to collection
agencies, are available in certain cases. Processes that improve existing cash flow, such as revenue cycle management, lockboxes,
electronic claim submission and billing, and precertification procedures, can also be
addressed.
Overhead Reduction
Smaller practices typically do not have the economies of scale or
availability of resources to effectively reduce overhead. MediCo Unlimited utilizes proven operations
management and cost accounting methodologies, in conjunction with strategic alliances, to offer
leading edge options to control cost. Whether the client needs a solid budgeting
process, analysis of certain business segments, expense review, improved efficiency of front desk or billing staff,
or better access to system information, we can provide that direction.
We can also recommend how to effectively outsource certain tasks or help
bring the client and vendors together. MediCo’s strategic alliances in
telecommunications and coding compliance, among others, help ensure a low cost,
high quality operation of the client's practice.
Cost Analyses
We provide accounting tools for the client's
administrative team to quickly assess cost of providing certain services, the
cost to see each patient, how a capitated contract equates to a fee-for-service
rate, what drives each aspect of practice overhead, and the contribution to
profit goals for new and existing contracts. The benefit of such operational analyses is the ability to
reduce the cost of care for your patients (a critical component of negotiating
as a group), set your fees based on actual data, and ultimately make your
practice more profitable.
Corporate Finance & Bank Management
Financial services are where significant sums of “hidden” cash reside in
health care practices. Inefficient use of banking vehicles, inappropriate
borrowing methods, hidden fees, and similar problems quietly drain cash from
practices. MediCo Unlimited’s principal has experience financing over $400 million of
debt and equity. He works with clients to ensure that they have a cogent
financial plan and that they employ all of the necessary tools to maximize
return on investment. Services include:
- Analyzing equipment lease versus buy situations,
- Developing equipment turnover strategies,
- Recommending advantageous debt strategies,
- Minimizing banking and credit card fees,
- Implementing cash flow improvement strategies,
- Working with lenders regarding debt issuance, obtaining favorable loan
rates, implementing electronic banking options, and solving corporate cash
management issues.
Benchmarking Solutions
Without benchmarks to measure performance, a practice has no idea if it is
progressing in the right direction. MediCo Unlimited has the ability to develop and maintain the same high quality benchmarking solutions available in large practices and hospitals. Our
solutions are tailored to your needs, so you never have “too much” information
or pay too much to get it.
Medical Economics Reports -
Utilizing data captured in the client's billing and accounting systems, we
can set up and track practice performance vis-à-vis similar practices across the
country. The economic reports can capture a variety of information in a trend
line or cross-sectional manner. Examples include procedure ratios, utilization
and QA data, staffing ratios, operating cost comparisons, space
utilization comparisons, accounts receivable benchmarks, just to name a few.
This data is a goldmine that can be utilized internally to improve performance
or shared with payors, hospitals and employers to show "best in class"
performance and earn a "preferred provider" status with each.
Provider Profiling -
MediCo can design, implement, and help managers monitor a provider profiling
program. Such a program will give valuable feedback concerning all types of
productivity and profitability measures. This data can be used to compare your staff to other
practitioners across the United States, or even in the same practice. Data can
also be used for provider certification needs. Such a program can be detailed in monetary terms,
Resource Based Relative Value Units (RBRVUs), or other non-monetary measures that will allow
for incentivized compensation plans.
Payor Profiling -
MediCo can also benchmark payor performance so the client can see problems
before they become insurmountable.
Market Surveys - MediCo Unlimited's wide information network enables us to conduct market
surveys (primary research) that will provide peer group information to your
practice when such data is not readily available from other secondary sources,
such as Medical Group Management Association. Examples of such surveys
include physician extender productivity benchmarks, payor contract comparisons,
and billing surveys.
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The health care climate today is wrought with burdensome requirements placed
upon health care practices, no matter if they are large or small. Larger
practices can more readily afford to employ full time staff to develop, monitor,
correct and enhance compliance and risk management programs than can smaller practices. MediCo Unlimited can
create programs and work
with area healthcare attorneys to ensure smaller practices have the same level of compliance with
federal and state regulations as do larger firms.
Regulatory Compliance
Quite often, smaller practices are not fully aware of the requirements of
regulations relating to HIPAA, Stark II, Anti-Kickback, Medicare Fraud & Abuse (coding), ERISA
/ Human Resources, VEBA / Employee Benefits, and
Escheat (refunds). While MediCo Unlimited is not a legal firm, it can, in conjunction
with the client's own legal firm or MediCo's affiliated legal resources, provide
a quality review of existing client controls, identify the highest risk areas, and implement sound
programs to ensure that the practice is complying in good faith with the law.
Our HIPAA Online Training is one compliance tools that is cost effective and
requires no time to manage.
Coding Compliance
Compliance efforts often start with coding
compliance (how accurately providers code services rendered and how accurately those services are
billed). We utilize
certified coding specialists to review charts, compare results against national averages, and
recommend improvements.
MediCo Unlimited utilizes certified coding (CPC) specialists to fulfill a
basic need of every practice; making sure they are billing within the
guidelines of the law. MediCo's principal also sits on the editorial advisory
board of several Coding Institute publications. The benefits of this service
include increasing revenue through proper coding, quicker payment and overall
improved cash flow, as well as decreased risk of obtaining adverse payor audit
results. Services include:
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Monthly selective chart audits of
each provider (i.e., prepayment audit review, post payment audit review,
hospital visit reviews, office visit reviews)
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Annual comprehensive coding audit
and analyses
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Training options for providers
and staff (i.e., using modifiers correctly, coding hospital visits, new
patient vs. consultation coding)
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Developing coding policies and protocols
Insurance Risk Management
Practice insurance coverage may be too little or not appropriate given the
smaller practices needs. MediCo Unlimited can review current coverage and can
work with quality brokers to protect practice assets and revenue streams in a
variety of innovative ways. For example, insurance plans that protect against billing errors and omissions or
guarantee revenue streams in uncertain times (such as when federal mandates are
being enacted like the Electronic Transactions & Code Sets provision of HIPAA) are available for consideration.
The benefits of a healthy compliance and risk management program are enormous.
A healthy plan can guide employees to "do the right thing" and to "do things
right", stop investigations at the preliminary stages, and reduce civil and
criminal penalties in the event of an adverse investigation. All it takes
is one disgruntled employee or patient to begin an investigation - even an
unwarranted one.
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There is no doubt that the wave of the future is online
physician-patient communication. Having your own website is also a
phenomenally low cost way of marketing your practice. MediCo Unlimited,
LLC offers practices a low cost website solution designed to better reach your
patients. If you like the look of this website, or the look of the
following websites designed by our company, then call us to help you design an
internet presence for your practice.
The Surgical Group of Kansas City, P.C.
SKIN Cosmetics
OrthoKC
Coffeyville Orthopaedics, P.A.
Trans World Transportation Services, LLC
Prime Roofing, Inc.
Make no
mistake, you can pay $5,000 - $10,000 for a truly state-of-the-art website
from certain designers. Custom graphics alone may cost thousands of
dollars. Alternatively, "website in a box" solutions from general or
industry specific ISPs, or domain name
registrars (costing around $10 per month), often lack even the most basic support
features. We offer a professional looking, inexpensive
alternative. Using your text, we will:
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Design the site
based on your needs
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Work with the
ISP to set up accounts and upload the site
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Obtain domain
names and email addresses
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Maintain the
website on an ongoing basis
Best of all we have a no-risk
policy. If you do not like the website design, you don't have to
pay us. The cost for an approved website can be as low as $100 per page.
Ongoing maintenance is charged on an hourly basis, in 15 minute increments. Call us to learn more.
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